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Heart failure and the brain: new perspectives.
Robert B Felder1, Joseph Francis, Zhi-Hua Zhang
1Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA. felder@uiowa.edu
Summary
Heart failure involves neurohumoral overactivity. The forebrain, particularly the hypothalamus, senses peripheral signals and drives sympathetic activation, worsening heart failure. Targeting forebrain pathways may offer new heart failure treatments.
Area of Science:
- Cardiology
- Neuroscience
- Endocrinology
Background:
- Heart failure prognosis remains poor despite advances.
- Neurohumoral overactivity is key to heart failure progression.
- Peripheral targets are primary interventions.
Purpose of the Study:
- Investigate the central nervous system's role in heart failure.
- Examine forebrain involvement in heart failure pathogenesis.
- Identify forebrain signaling pathways for therapeutic targets.
Main Methods:
- Review of laboratory studies on ischemia-induced heart failure.
- Analysis of forebrain sensing of peripheral signals.
- Emphasis on renin-angiotensin and immune system signaling.
Main Results:
- The forebrain senses peripheral signals in heart failure.
- Forebrain contributes to altered volume regulation.
- Forebrain enhances sympathetic drive in heart failure.
Conclusions:
- The forebrain plays a critical role in heart failure pathogenesis.
- Forebrain signaling is crucial for volume regulation and sympathetic drive.
- Therapeutic strategies must consider forebrain contributions.